EYE-ECG: An RCT of the influence of student characteristics and expert eye-tracking videos with cued retrospective reporting on students' ECG interpretation skills.

Objectives: Teaching of ECG interpretation frequently relies on visual schemas. However, subsequent student ECG interpretation skills are often poor. Expertise research shows that expert looking patterns frequently deviate from the steps taught in schema learning. The present study made a cardiology expert's gaze interpreting ECGs visible - through eye-tracking videos with cued retrospective reporting (CRR) - and investigated the potential as an additional expert-driven route to improve medical students' ECG interpretation skills.

Methods: N=91 Medical students participated in the RCT of an ECG e-learning session aimed at medical students' ECG interpretation skills gain, either receiving the newly developed eye-tracking video with CRR audio commentary materials (n=47) or studying via four clinical cases only (n=44). Three outcome scores relating to different aspects of ECG interpretation skills were derived from pre-post MCQ ECG tests. The effect of the EYE-ECG training and additional characteristics (e.g., prior experience, interest) on student ECG interpretation skills were evaluated using t-tests and multivariate linear regression.

Results: A small, non-significant advantage of the EYE-ECG training signifying a tendency for greater knowledge gain was observed, compared to training as usual. In multivariate regression models, the predictive value of clinical case 1 was an unexpected finding warranting further exploration.

Conclusion: Additional gains after an only 9-minute intervention using videos of expert's real-time gaze pattern in combination with hearing their thought processes during ECG interpretation is a promising finding. Furthermore, a number of specific performance characteristics enabling students to best benefit from ECG training were identified and possible modifications to the learning intervention suggested.